Laserfiche WebLink
5400 Legacy Drive,Cluster II,B3 800.669-5740 DUNS NO. 05-3976551 FED,ID NO. 396090019 "J/ I VNIE H <br /> Plano,Texas 75024 W W W.salery-INlean.com FOR SERVICE CALL BRANCH MANAGER DOC.EXP. HEINJ ED scHEDDEEo <br /> p)q CUSTOMER NO. 09-545-1011 UBEN MARTINEZ 7ERYIDE WEEK TERRITORY 004128707 <br /> C — `A L/ Z — 1/ COIx PREVIOUS BALANCE <br /> U <br />$ ,�L�� / �J"( y�� `,�r"Y-r� S BUSINESS OUTEfl <br /> T <br /> 1 /3 l 'P a/ ) / TYPE CHAIN COUNTY SVC.P/C I PROD.P/C <br /> M %ZL.9N <br /> LOCATION TAX EXEMPTION NO. <br /> E S-7-CK7;A7 G 6. <br /> R <br /> SERVICE DATE SAL A.. CUSTOMER P. .NUMBER CUSTOMER PHONE# TAX CODE HANDDE G AssocIr— COM SERVICE TAX C.O.M.S.TAX PRODUCT TA% <br /> r a ?° 7-191 <br /> SERVICE/ REMARKS/ SALES TOTAL WASTE SOLVENT/DRUMS SERVICE IN. PROMO MSOS <br /> DEPT PRODUCT NUMBER UNIT PRICE DUAN. CHARGE TAX CHARGE MIN. cLFM SPENT ' SK DOT CC TERM SERVICE TERM sm wre ME NO. GIVEN <br /> m wl <br /> 1 /�oea5 'i.( S/tr/ t .. v / ❑ <br /> 3 ❑ <br /> 4 as N.PXPp ❑ <br /> 5 1111ei 114ft ❑ <br /> 6 ❑ <br /> 7 .' ElH r:. <br /> ❑ <br /> 9 ❑ <br /> 10 I ❑ <br />!1 ❑ <br /> 12 ❑ <br /> L CHECK GODO POOR OfGLSWRACE YES NO MACHINE PROPERLY GROUNDED <br /> AS NO <br /> Tr)TAl_CFGVIt:F/PFlflTll IRTA QQP� APPROPRIATE ..._..._.._.____ .._..._.. n n n n F— <br /> ..._---...._ / BOXES 6CLFANLNESS,M• U U FUMBLE LINK y V LOG.PHONE NO.STICKER Z <br /> ❑ F] AFWEOTOMAO NE El El W <br /> U EPATRANSPORTER ENE <br /> 1 ID NO. USEPA TRANSPORTER 21D NO. GENERATOR USEPA IDNO. GRATOR STATE ID NO. uMPAssEMav ❑ ❑ B.ENSIA LvcLaslxG sRIxr sDLvexrMEETs 2 <br /> COHDMON of UD UNOBSTRUCTED ❑ ❑ ACCEPTANCE MITwM ❑ ❑ 01 <br /> 11.US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME,HAZARD CLASS,AND ID.) 12, AINFfls 13. TOTAL u.UNIT SK COT NUMBER I CERTIFY THAT My TOTAL <br /> NO. TYPE UMTHY V? WASTE STREAMS ME W.I. W <br /> Q (/A A.2 ,,e 70G, (( /Aj7' r,` L- vl/)5 /JM ,}!./ /y ''j ONE of THE FouOvnNc <br /> PA 6VVV � V �61J TEWPoES. Z <br /> O TEGORES/MONTH <br /> NRN S Y. <br /> 3. <br /> MUMS TOL) <br /> UISJMONTH <br /> INITIALS W <br /> GREATER THAN 2.20DUIS41AYRHD. ..1 <br /> yN <br /> INITIALS QO <br /> DESIGNATED FACILITY NAME AND ADDRESS S I ,N) GERTFY THAT NO MATERwL cHANGF HAs oc =Eo USA EPA ID NO. Z^'1 <br /> EITHEfl IN THE LW1MCiERI511G5 OF THE WPSTE aQ <br /> (' �(� tp WEVORu ME PROCESS GENERATING THE STATE ID N0. W <br /> O-ggH ❑ // TOTAL RECEIVED APPLY P HENT TO: ( .' 7 VvMANIFESTNG. I AGREE TO PAY THE ABOVE CHARGES MO TO BE BOUND BY THE TERM AND TOTAL CHARGE _V <br /> COAOTHONS SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT. (FROM ABOVE) >P- <br /> CHECKNUMBER ❑TOMMS SERWCEISVIE C/ 1 I PLEASE CHARGE MY ACCOUNT FOR THIS TMNSACTION UNLESS OTHEN.SE ¢0: <br /> INDICATED IN THE PAYMENT RECEIVED SECTION,THE INDMWK NOSHING TNIS WASTE MIN. W Q <br /> ❑FRENDLa 6AlµCE AS LDR MESSAGE' DOCUMENT xi WLY AUTHORIZED TO SION AND WIND CUSTOMER TO RSrERMS. (FROM ABOVE) EA <br /> INVOICE Y AMOUNTS INVOICEY q NTE 0 / yQ 'e�Yh .wAwN.,.w.aw Nera'�m.e 1, <br /> vVld �,m�a>.�.mrA..�aemm..PdnN.'.Mwa.am.wl.e�++ar�.�wl+e,.' TOTAL DUE C� C �fr) <br /> PREVIOUS _ _.. . -. - - MANIFEST CODE SEOY �j (� Mao <br /> CREDIT y !'✓�LGJ��//I /��Y" DO NOT WRITE IN THE AREA BELOW <br /> CARD 0 - Prim CuslOmer Nemo MO U 412$7 07 <br /> RED AD No AMEX <br /> WA ri 'K� (l ✓ 026013 <br /> By: <br /> Custmel's Aulhaizea RepreMH eUV, <br /> CUSTOMER REFERENCE .. .. <br />